Determining the Impact of Swallowing Impairment in People recovering from Severe COVID-19 Infection

项目概要/摘要 最近的 COVID-19 传播已导致一场国际大流行，迄今为止确诊病例已超过 400 万例 全球范围内，其中美国报告了超过 130 万例确诊病例和超过 8 万例死亡。感染者 个人通常会出现严重的呼吸困难和肺炎，导致入院 以及需要重症监护和机械通气。新的证据表明味觉受损 和气味可能是这种疾病的早期标志，在严重的情况下，可能会出现神经损伤 延髓是呼吸和吞咽的重要脑干控制部位。鉴于 呼吸和吞咽的神经解剖学调节重叠，我们假设吞咽困难 （吞咽障碍）在重症 COVID-19 (PrSC-19) 康复者中很常见，并且 与较差的结果相关。通过这笔赠款补充，我们建议扩展我们现有的工作 表征不同临床人群的吞咽困难概况，以研究吞咽困难及其对 PrSC-的影响 19. 为了了解 PrSC-19 中吞咽困难的患病率和病理生理学，我们将进行详细的研究 在标准护理期间、出院后从重症监护室到 急症护理机构内的常规医疗护理单位。鉴于目前执行方面的限制 为了对 COVID-19 检测呈阳性的住院患者进行吞咽评估，我们还将建立 3 个区域 研究诊所将为 PrSC-19 急性出院后提供全面的吞咽评估 关心康复或社区。这些评估将包括收集病例历史 信息、视频透视、使用新型数字听诊器测量呼吸吞咽 协调性、吞咽困难其他危险因素的测量（例如延髓肌力量）和患者报告 结果。对视频荧光检查的详细分析将确定秋季吞咽的具体措施 根据与通过建立的健康参考值的比较，超出正常变化范围 我们的研究项目探索不同稠度液体的吞咽生理学。

Project Summary/Abstract The recent spread of COVID-19 has led to an international pandemic, with >4 million confirmed cases to date worldwide, of which >1.3 million confirmed cases and >80,000 deaths have been reported in the USA. Infected individuals commonly experience severe respiratory difficulties and pneumonia, leading to hospital admission and the need for intensive care and mechanical ventilation. Emerging evidence suggests that impaired taste and smell may be early markers of the disease, and that in severe cases, there may be neurological damage in in the medulla, an important brainstem control site for both respiration and swallowing. Given the overlapping neuroanatomical regulation of breathing and swallowing, we hypothesize that dysphagia (swallowing impairment) will be common in People recovering from Severe COVID-19 (PrSC-19) and associated with poorer outcomes. Through this grant supplement, we propose to extend our existing work characterizing dysphagia profiles in different clinical populations to study dysphagia and its impact in PrSC- 19. To understand the prevalence and pathophysiology of dysphagia in PrSC-19, we will conduct detailed analyses of videofluoroscopies performed during the standard of care, post-discharge from intensive care to regular medical care units within the acute care setting. Given the current limitations in performing swallowing assessments for inpatients who test positive for COVID-19, we will also establish 3 regional research clinics that will offer comprehensive swallowing assessments to PrSC-19 after discharge from acute care to rehabilitation or the community. These assessments will include the collection of case history information, videofluoroscopy, use of a novel digital stethoscope to measure respiratory-swallow coordination, measures of other risk factors for dysphagia (e.g. bulbar muscle strength) and patient-reported outcomes. Detailed analyses of the videofluoroscopies will identify specific measures of swallowing that fall outside the range of normal variation based on comparison to healthy reference values established through our research program exploring swallowing physiology on liquids of different consistencies.